Public hospital abortions and cheaper contraceptives needed, inquiry finds

All public hospitals should offer surgical abortions or steer patients to affordable providers and the abortion pill should be easier to prescribe, says a Senate inquiry that found reproductive healthcare is a postcode lottery for many women.

The Greens-led inquiry also recommended cheaper access to contraceptive pills and long-acting birth control amid concern it costs women hundreds of dollars they cannot always afford.

Greens senator Larissa Waters says there are too many barriers to abortion, contraception, sexual healthcare and maternity services.Credit: Alex Ellinghausen

Greens senator Larissa Waters, part of the 10-person inquiry, said there were currently too many barriers to abortion, contraception, sexual healthcare and maternity services.

“People shouldn’t have to spend hundreds of dollars and travel hundreds of kilometres to get an abortion. Contraception is crucial to giving people more control over their reproductive choices,” she said.

“Half the battle is figuring out where you can go to get an abortion or advice on contraception. A national hotline will provide a single touchpoint for people to find reproductive healthcare where and when they need it.”

Assistant Health Minister Ged Kearney said the government was committed to ensuring equitable access to healthcare.

“We welcome the report from the Senate inquiry into the universal access to reproductive healthcare and will now consider its recommendations,” Kearney said.

Waters said the Greens would push to have the inquiry’s recommendations implemented.

The inquiry’s report estimated one in four Australian women experienced an unintended pregnancy in their lifetime, with a higher rate in non-urban areas.

About two in three women aged between 18 and 44 use some form of contraception and 83 per cent have used it at some point. But many newer birth control pills are not on the Pharmaceutical Benefits Scheme (PBS) and can cost more than $80 a script – about three times more than older pills that have potentially worse side effects.

Long-acting contraceptives are also expensive, with a copper intrauterine device costing $90 before doctors’ fees. The inquiry heard that only about 11 per cent of Australian women had used long-acting options, despite a much larger take-up overseas.

“The high financial costs of accessing contraceptives were seen as a key barrier to their universal access,” the report said.

The inquiry recommended a new Medicare item for contraceptive counselling, more funding for health practitioners to insert long-acting contraceptives, and for the national health department to work with the pharmaceutical industry to improve access to contraceptives through the PBS. While 23 common brands are listed on the scheme, 26 are not.

The report noted Australia lacked adequate clinical services for abortion care, which it said was leading to long waiting lists and lengthy travel times.

The Centre of Research Excellence in Sexual and Reproductive Health for Women said 30 per cent of women in Australia, and half in remote areas, lived in regions without local GP provision of medical abortion.

Professor Danielle Mazza, the chair of general practice at Monash University, said about 3000 GPs were registered to provide medical abortions but fewer actually did so, with stigma and poor support from colleagues common deterrents.

And while surgical abortions are legal in all states and territories, many publicly funded hospitals do not provide the service.

The Royal Women’s Hospital in Melbourne said that was because public hospitals were not mandated to provide surgical abortion care through state government directives or funding agreements.

One speaker told the inquiry her clients travelled an average of 200 kilometres to access abortion. Another estimated one in 10 women required overnight stays when they had a termination, due to the distance they had to travel; while 4 per cent had to travel interstate.

The inquiry said the Therapeutic Goods Administration and MS Health, the only Australian supplier of the abortion pill, should reduce training requirements and allow more health practitioners to prescribe the medication.

It also said all public hospitals should be equipped to provide surgical abortions. If not, they must offer timely and affordable pathways to other local providers.

A national telephone service and referral model for reproductive healthcare services was another recommendation, as was improving government data collection on both contraception and abortion.

Labor took a policy to the 2019 election that would require public hospitals to provide abortion services to qualify for federal funding, but dropped the promise from last year’s election platform.

Asked earlier this month whether it was still Labor policy, Health Minister Mark Butler said he believed in equitable access and expected the inquiry to flesh out how that principle could be put into practice.

Butler anticipated that would require working with state governments, but delayed committing to a specific policy while the inquiry was under way.

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